| NPI | 1730255910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00031900) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD171815) |
| 207Q00000X Family Medicine (Licence: WA ML20003806) | |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2019-07-23 |